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Causes, Diagnosis, and Treatment
Dogs should pass urine multiple times a day. A sudden difficulty or inability to pass urine is a true emergency that needs addressing right away. Left untreated, a urinary blockage can lead to severe pain, bladder rupture, kidney failure or even death.
There are a number of potential causes and the treatment plan will depend on why your dog isn’t urinating. This article discusses what can lead up to a urinary blockage, the warning signs every pet owner should be aware of, the diagnostic and treatment steps undertaken at the veterinary clinic, and practical ways you can prevent urinary issues in your pet going forward.
Urinary retention is when your dog is producing urine but it is retained in the bladder and is not passing out of the body. If a dog is not peeing, it may have urinary retention, but there could be other issues at play such as anuria (no urine being produced by the kidneys), or a psychological refusal to void urine due to e.g. extreme stress.
As both behavioural and medical issues can be at play, it is important we establish exactly what the problem is, before rushing to treat the patient. A careful and thorough assessment should mean we can effectively address the root cause, rather than just managing symptoms.
Even the most observant owner will struggle to tell you definitively how many times their dog has passed urine in the last 24 hours. When all is working as it should, it is usually a bodily function we’re not particularly aware of. However, when there is an issue with their urination, you need to pay attention to what is (or isn’t) coming out. This way, you can hopefully catch a potentially serious issue before it escalates.
Some of the more common signs you’ll notice if your dog is having trouble urinating will include:
Straining, which can look like the dog is trying to pass poop
Whining or yelping
Licking of the genitals
Food refusal
Vomiting
Lethargy
Abdominal swelling
Frequently asking to go outside
Urine dribbling or small indoor accidents
Panting, restlessness and other signs of distress
When a vet is presented with a dog who is not peeing, they’re going to want to know their age, breed, medical history, and neutered or spayed status. By piecing together all of this information, the vet can then take a targeted diagnostic approach, to quickly work out what the problem is.
The most common reasons for dogs not passing urine are medical and include bladder stones, bladder tumours, prostate enlargement (in male dogs) and acute kidney failure.
If a dog has a urinary tract infection, they often strain until the bladder is totally empty, and then strain some more. These dogs can appear to have a blockage, but on examination their bladder will be close to empty.
Some dogs will consciously hold their urine, making their owner concerned. This is much less worrying than a medical issue, as the dog will eventually urinate when they need to. We see dogs urine holding when they’re very stressed, for example if their owner has gone on holiday and left them in kennels, or if they are kept inside a crate for too long.
We see trouble with urine passing more often in older dogs, particularly unneutered males. This is because these dogs are prone to BPH (Benign Prostatic Hyperplasia). With time, testosterone causes the prostate to enlarge and, in seniors, it can get so large that it causes the urethra to become more narrow, or to block completely. The urethra is the tube that carries urine from the bladder outside of the body.
A severely dehydrated dog is going to conserve any bodily fluids they have and will not pass urine normally. Any small amount of urine they do pass will be highly concentrated; dark brown and very strong-smelling.
Certain medications can affect how a dog urinates. Some opioids and anaesthetics have a relaxing effect on the bladder wall, meaning it isn’t able to empty as it normally would. An uncommon side effect of medicines like NSAIDs or chemotherapy is acute kidney failure and anuria.
Absolutely, urination is an essential bodily process and going more than 12 to 24 hours without urinating is a red flag. A healthy dog can become critically ill– developing salt imbalances, kidney failure and going into shock– within just a day or two of not being able to pass urine.
Prompt veterinary intervention is needed to ensure the patient survives. At the first sign of trouble when it comes to urinating, contact your local vet right away. Depending on the time of day, this may mean calling the emergency out of hours vet.
As touched upon, successful therapy begins with making the right diagnosis, and establishing the exact reason as to why urine is not being passed.
Your vet will take a detailed history from you and will also check your dog’s medical history, to see if they’ve had any similar episodes in the past. They’ll want to know about any medication your dog is on and any potential toxin exposure.
They’ll perform a nose to tail exam, assessing the capillary refill time (how long it takes for the gums to return to normal colour after being pressed) and moisture of the gums (to check hydration levels), and palpating the bladder and kidneys.
For unneutered males, a rectal exam will be performed to establish the size of the prostate gland, and to check for any tenderness.
Some of the tests that will be performed will include:
Blood Tests: Haematology to check for infection markers and to help determine the level of hydration, and biochemistry to assess kidney function and electrolyte (salt) levels.
A urine analysis, which will look at the specific gravity (concentration) of the urine, as well as the protein and sugar content. The urine can also be cultured for any infection and evaluated under the microscope to check for any blood, bacteria or crystals.
Imaging, such as X-rays and an ultrasound scan of the urinary tract. These imaging studies can assess the size and structure of the kidneys, and can establish if there are any mechanical obstructions along the urinary tract, such as urinary stones, an enlarged prostate gland, or a mass.
Less commonly, your vet may discuss a test called cystoscopy. A small, flexible camera (cystoscope) is passed into the urinary tract to inspect it from the inside, checking for issues such as strictures (narrowing) or physical obstructions.
It is an uncomfortable procedure that is performed under anaesthetic. One main benefit of a cystoscopy is that it can be used to help locate urinary stones, which can then be broken up (via laser or ultrasound waves) and flushed out.
Treatment for a failure to pass urine cannot be delayed. The goal of the vet is to remove any urine which has built up, support the kidneys, and to get the patient urinating by themselves once again.
A catheter (tube) may be passed into the bladder, to directly drain the urine that has built up. This is usually done under sedation or anaesthetic, and a saline flush is used to remove any debris or small stones that are present.
The catheter is often left in place for a day or two to establish urine flow and so we can measure the urinary output of the dog.
These patients typically need medications such as pain relief and anti inflammatories, to help support them. As many dogs will be dehydrated or dealing with abnormal salt levels, an intravenous fluid drip will also be needed. If potassium levels are high, drugs (such as calcium gluconate) will be given to lower these back to normal.
Surgery is usually scheduled for after the patient has fully recovered from the urinary retention episode. Less commonly, if a catheter cannot be passed, the surgery will be performed as an emergency.
A cystotomy is the name for the procedure when the bladder is opened up, in order to remove any stones or other obstructions. It is safer to operate on the bladder than the urethra, so the vet would usually try to flush whatever is in the urethra back up to the bladder before operating.
For some patients, they will be started on a prescription urinary diet that needs to be fed exclusively. Your vet might also discuss the use of daily supplements, to support bladder wall health.
Patients will need to be closely followed up, and this may include further imaging and urine analysis, to check for any recurrence of infection or stones.
Those who have had one episode of urinary blockage are at a higher risk of developing another in the future. For this reason, owners should be aware of what they can do to mitigate the risk.
Your vet is in a good position to try and spot medical problems before they cause major issues. Something like an annual prostate exam in an older male can help identify prostate enlargement, so it can be treated before it leads to a blockage.
Poor hydration is a big risk factor when it comes to developing issues such as urinary crystals and urinary tract infections. Encourage your dog to drink water and you can also add water to their meals, offer wet dog food and provide dog safe broth and ice cubes.
Try to provide your pet with a complete and balanced diet and avoid giving any unnecessary supplements. Providing too much of certain minerals can cause stones to develop.
Although it can be frightening to discover your dog cannot pee, prompt treatment from a vet should ensure they recover well from the episode. As this is a condition which can progress rapidly– causing kidney failure and shock– owners should not hesitate to contact their local veterinary clinic for immediate evaluation.
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